Provider Demographics
NPI:1578614103
Name:BANG, DENNIS J (MD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:J
Last Name:BANG
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:691 S HARVARD BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-2513
Mailing Address - Country:US
Mailing Address - Phone:213-235-5388
Mailing Address - Fax:475-313-1265
Practice Address - Street 1:691 S HARVARD BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-2513
Practice Address - Country:US
Practice Address - Phone:213-235-5388
Practice Address - Fax:475-313-1265
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60220208200000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4651925OtherCIGNA
CA00A602200OtherBLUE SHIELD OF CA
CA00A602200Medicaid
CAW16157Medicare ID - Type UnspecifiedMEDICARE
CA00A602200OtherBLUE SHIELD OF CA
CA00A602200Medicaid